Hepatitis B Envelope Antigen in Children and Adults with Hepatitis B Infection in Tertiary Health Facility in North East Nigeria During the Period 2000-2015

Research Article

J Hepat Res. 2021; 6(1): 1045.

Hepatitis B Envelope Antigen in Children and Adults with Hepatitis B Infection in Tertiary Health Facility in North East Nigeria During the Period 2000-2015

Isaac WE1*, Jalo I1, Ajani A2, Oyeniyi CO3, Abubakar JD4, Aremu JT5 and Danlami MH6

1Department of Paediatrics, College of Medical Sciences, Gombe State University, Nigeria

2Department of Paediatrics, Federal Teaching Hospital, Gombe, Nigeria

3Infectious Diseases Training and Research group, Gombe, Nigeria

4Department of Community Medicine, College of Medical Sciences, Gombe State University, Nigeria

5Department of Internal Medicine, Federal Teaching Hospital, Gombe, Nigeria

6Department of Medical Microbiology, Federal Teaching Hospital, Gombe, Nigeria

*Corresponding author: Isaac Warnow Elon, Department of Paediatrics, College of Medical Sciences, Gombe State, Nigeria

Received: June 04, 2021; Accepted: July 06, 2021; Published: July 13, 2021


Introduction: Worldwide, most people living with chronic HBV infection are in in low- and middle-income countries. Most of the burden of disease from HBV infection comes from infections acquired before the age of 5 years.

Materials and Methods: Records of Hepatitis B surface and envelope antigen results of children and adults in Federal Teaching Hospital, Gombe between May 2000 and May 2015 were analyzed

Results: 22,862 individuals were tested for Hepatitis B surface antigen. 19.5% (4456) tested positive. 24.7 % (3146) and 12.9% (1310) of males and females respectively were HBsAg positive. HBsAg Peak prevalence of 21.8% was in the age group 26-46 (2533) and the lowest prevalence in infancy (3.5%). Amongst males, the 19-25year age group had the peak prevalence of 28.6% and in females the age group 5-9 years constituted the highest (20.3%). 36% (1602/4456) of HBsAg positive children and adults were tested for HBeAg. 26.2% (420/1602) of individuals with HBsAg carriage were HBeAg. More males (307/1105) than females (113/495) were HBeAg positive but not statistically significant. (P=0.034). Prevalence of HBeAg was highest in infants (50%) and children 1-4 years (50%) age group and thereafter declined with increasing age. Females of the younger age group <1year, 1-4 years and 5-9 years and older age group, 56-65 and >65 years, compared to their male carriers of HBsAg had higher prevalence of HBeAg but these were not statistically significant.

Conclusion: A fifth of HBsAg carriers were HBeAg positive and HBeAg positivity decreased with increasing age. Hepatitis B vaccination in Nigeria requires urgent strengthening. Keywords: Hepatitis, HBsAg, HBeAg Children, Adults, Nigeria.


Globally, Viral hepatitis caused 1.34 million deaths in 2015, a number comparable to deaths caused by tuberculosis and higher than those caused by Human Immunodeficiency Virus (HIV) [1]. Most viral hepatitis deaths were due to chronic liver disease and primary liver cancer. There were 720 000 deaths and 470 000 deaths due to cirrhosis and hepatocellular carcinoma respectively [1].

Worldwide, in 2015, an estimated 257 million people were living with Chronic Hepatitis B Virus (CHBV) infection and most living in low- and middle-income countries [1,2].

Hepatitis B infection is endemic in sub-Saharan Africa where >6.1% of the general population are chronic carriers of HBV and transmission predominantly occurs in infants and children by perinatal and horizontal routes [1,3,4]. The risk of chronic infection peaks when infection is acquired early [1,2]. Most of the burden of disease from HBV infection comes from infections acquired before the age of 5 years. Therefore, prevention of HBV infection focuses on children under 5 years of age [2]. Worldwide, the majority of persons with CHBV were infected at birth or in early childhood [2,3].

Immunization is the most effective measure to prevent the transmission of HBV [1,2]. In 2014, the World Health Organization (WHO) reaffirmed the need for hepatitis B vaccines to become an integral part of national immunization schedules [2]. WHO recommends a birth dose within 24 hours of birth to prevent perinatal and early horizontal HBV transmission [1,2]. The birth dose should be followed by 2 or 3 doses of monovalent or multivalent hepatitis B vaccines [1,2].

Access to affordable hepatitis testing is limited. Few people with viral hepatitis have been diagnosed (9% of HBV-infected persons, 22 million, and 20% of Hepatitis C Virus (HCV)-infected persons, 14 million) [1]. Infection with HBV may present as either Hepatitis B “e-antigen” (HBeAg) positive or -negative disease. Hepatitis B “e-antigen” is seen in many HBeAg-positive children and young adults, particularly among those infected at birth [1,2].

In persons with CHB, a positive HBeAg result usually indicates the presence of active HBV replication and high infectivity. Those who are HBeAg negative, usually anti HBe positive, have lower risk of transmission [1,2]. Being a non-structural protein produced by actively replicating HBV, HBeAg is detectable early in the serological course after exposure to HBV, usually after the first months of infection. Clinically, HBeAg is an index of viral replication, infectivity, inflammation, severity of disease and response to antiviral therapy [5].

In Nigeria, Hepatitis B vaccination was started in 2004 and currently 3 doses are administered at birth, 6 weeks and at 14 weeks [6]. The most recent estimate of Hepatitis B vaccination coverage at birth with valid evidence is 11% [7] and 49% for 3rd dose of Hepatitis B vaccine in the country [8].

Demand, supply and systemic side barriers have impacted on vaccination in Nigeria. Low level of community participation, inadequate cold chain infrastructure and poor funding for routine immunization amongst other factors remain barriers to improving immunization coverage in Nigeria [7,8]. A National survey of Hepatitis B in the general population in 2013 of the six geo- political zones of Nigeria showed the national prevalence of 11%with the highest prevalence of 19% in Taraba State [9]. The northern zones have higher prevalence rate of Hepatitis B.[9]

Recent Nigeria studies from Jalingo [10], Kaduna [11], Sokoto [12], Kogi [13] and Makurdi [14] showed the prevalence of Hepatitis B Virus of 19.2%, 14%, 63%, 25% and 39% in various adult subpopulations of hospital patients respectively. Hepatitis B testing methods were different.

Recent reports [15-22] of Hepatitis B infection in children in Nigeria showed a wide and varying prevalence of 0.5% to 44.7%. These differences in prevalence could be related to age group, sample size and laboratory method used [23]. However, a pooled analysis of HIV prevalence in children found a prevalence of 11.5% [23].

In Nigeria, recent studies on dual carriage of HB-surface and Envelope antigens in children[21, 22, 24,] and adults [25-27] have contributed significantly to understanding of the disease but however were limited in sample size, age and sex disaggregation and study duration.

Most of these studies [21,22 24-27] on HBV prevalence and e antigen have used biomarkers such HBsAg and anti-HBc, or the status of Hepatitis B envelope antigen were generally not reported. Hepatitis B envelope epidemiology is crucial and an important marker for perinatal transmission and HBV related disease burden and treatment [1,2,5]. The objective of this study is to report the dual carriage of Hepatitis B surface and Envelope antigen in Children and Adult Nigerians from 2000- 2015 in a tertiary health facility.


Study area

Gombe is the capital of Gombe state. Gombe state is one of the six states that comprise North East Geopolitical zone in the country and one of the geopolitical zones with the highest levels of poverty and worse maternal and child health indices in Nigeria [28].

Study setting

This study was conducted in Federal Teaching Hospital Gombe, a 500-bed hospital serving Gombe and neighboring states. The Federal Teaching Hospital, Gombe (FTHG) started providing services in the year 2000. It has emerged as a Centre for treatment, teaching and research in the sub region with large patient referrals from the neighboring states of Borno, Yobe, Adamawa and Bauchi.

Study population

All children and adults who presented to the out-patient departments, and those that were admitted irrespective of their HIV and or Hepatitis C virus status and had Hepatitis B and/or Hepatitis B envelope antigen test conducted from 2000 to 2015.

Laboratory methods

All children and adults were tested using the Hospital standard for Hepatitis B surface antigen test strip. The ACON HBsAg (ACON Laboratories, Incorporated San Diego, California, USA) is a rapid one step test for the qualitative detection of Hepatitis B surface Antigen and Hepatitis B envelope antigen in serum or plasma. The HBsAg test strip has a relative sensitivity, greater than 99.8% and specificity of 99.7%.

The ACON HBeAg (ACON Laboratories, Incorporated San Diego, California, USA). The HBeAg EIA Test Kit is a one-step enzyme immunoassay for the qualitative detection of Hepatitis B Envelope Antigen (HBeAg) in human serum or plasma.


The ACON HBsAg One Step Test is a qualitative, solid phase, two site sandwich immunoassays for the detection of Hepatitis B surface Antigen (HBsAg) and envelope antigen in serum or plasma. The membrane is pre-coated with anti-HBsAg antibodies on the test line region and anti-mouse antibodies on the control region. During testing the serum or plasma samples reacts with dye conjugate (mouse anti-HBsAg antibody-colloidal gold conjugate) which has pre-coated in the test strip. The mixture migrated upwards on the membrane chromatographically by capillary action to react with anti-HBsAg antibodies on the membrane and generates a red line. Presence of this red line indicates a positive result, while its absence indicates a negative result. Regardless of the presence of HBsAg as the mixtures continues to migrate across the membrane to the immobilized goat anti-mouse region, a red line at the control region will always appear. The presence of this red line serves as verification for sufficient sample volume and proper flow as a control for the reagents [29].

HBeAg principle

HBeAg in the sample first bound to anti-HBe antibodies coated on the micro-particles, and then the bound HBeAg was detected upon addition of anti-HBe antibodies conjugated to alkaline phosphatase. The HBeAg levels were evaluated using ratios of sample to cut-off values (S/CO), and HBeAg positivity was suggested if the S/CO was ≥1.0. Verification of test results was carried out by randomly retesting 5% of the specimens using the same kit.

Laboratory registers/Data collection

Records of Hepatitis B surface and envelope antigen results of children and adults in Federal Teaching Hospital, Gombe between 2000 and 2015 were retrieved. Variables analyzed included age, sex, year, month, and hepatitis B surface and envelope antigen.

Data analysis

All records were imputed into EPInfor Version 3.2 and analysed.

Ethical clearance

Clearance for this study was received from the Research and Ethical committee of the Federal Teaching Hospital Gombe.


Figure 1 shows the number of children and adults screened for HBsAg in our Health facility during the period 2000- 2015 and Figure 2 the number of HBsAg carriers that were tested for HBeAg.